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OB > INFECTIONS > Flashcards

INFECTIONS Flashcards

1
Q

vaginal pH

A

4-4.5

glycogen - present in healthy mucosal vagina

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2
Q

pH suggestive of menopause

A

6.0 to 7.5

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3
Q

MCC of vaginal discharge among reproductive aged women

A

BACTERIAL VAGINOSIS

nonirritating, malodorous vaginal discharge

unpleasant vaginal odor - musty or fishy

thin and gray white frothy

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4
Q

Diagnostic criteria for bacterial vaginosis

A

AMSEL CRITERIA (3 out of 4)

pH > 4.7
(+) clue cells
homogenous milky white discharge
release of fishy odor when KOH is added

microscopic evaluation of vaginal secretion saline preparation

release of volatile amines (w/ fishy odor) produced by anaerobic metabolism

determination of vaginal pH

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5
Q

vaginal pH of bacterial vaginosis

A

> 4.7 - d.t. DECREASED acid production of bacteria

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6
Q

Diagnostics of Bacterial Vaginosis

A

(+) clue cells
homogenous milky white discharge
release of fishy odor when KOH is added

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7
Q

Bacterial Vaginosis causes

A 
Gardnerella vaginalis
Ureaplasma urealyticum
Mobiluncus specieis
Mycopladma hominis
Prevotella species
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8
Q

Treatment for Bacterial Vaginosis

A

Metronidazole 500 mg/tab BID for 7 days
Metronidazole 250 mg/tab BID for 7 days
Clindamycin 300 mg/cap BID for 7 days

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9
Q

Maternal and Fetal Effects of Bacterial Vaginosis

A 
abortion
preterm delivery, PROM
chorioamnionitis, intraamniotic infection
postpartum endometritis
post cesarean wound infection
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10
Q

Highly contagious STI that is caused by a unicellular organism that is normally fusiform in shape

A

TRICHOMONIASIS

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11
Q

Symptoms of Trichomoniasis

A

dysuria, dyspareunia, vulvar pruritus, vaginal spotting, pain

foul, thin and yellow or green vaginal discharge

“strawberry cervix”

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12
Q

Diagnosis of Trichomoniasis

A 
saline wet mount - motile trichomonads
vaginal pH > 4.5 
culture - GOLD standard
pap smear (liquid based(
DNA probe
rapid test (antigen detection)
NAAT (urine or vaginal swab)
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13
Q

Maternal and Fetal Effects of Trichomonas

A

preterm labor and birth
PROM
postpartum endometritis
low birth weight infant

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14
Q

Management of Trichomoniasis

A

POGS Clinical Practice Guidelines

METRONIDAZOLE 2 grams single dose

partners should be treated
withhold Metronidazole until the 1st trimester
treat symptomatic pregnant women regardless of pregnancy

breastfeeding must be WITHHELD up to 12-24 hrs AFTER last dose

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15
Q

Manifestations of Vulvovaginal Candidiasis

A

vulvar pruritus - MC

thick white curdy discharge
erythema, irritation
external dysuria and dyspareunia

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16
Q

Diagnosis of Vulvovaginal Candidiasis

A

KOH (10%) or saline wet prep

normal pH (4.0 - 4.5)

17
Q

Treatment of Vulvovaginal Candidiasis

A 
AZOLE CREAMS
Butoconazole
Clotrimazole
Miconazole
Terconazole

RECOMMENDED FOR PREGNANCY
topical azole therapies (cream, suppository, tablet) applied for 7 days

FLUCONAZOLE - CONTRAINDICATED

18
Q

Causes of Suppurative (Mucopurulent Cervicitis)

A

Chlamydia trachomatis

Neisseria gonorrhea

19
Q

Maternal Effects of Chlamydia

A 
preterm labor with PROM
postpartum endometritis
PID
salpingitis
Fitz Hugh Curtis syndrome
Reiter's syndrome
20
Q

Fetal Effects of Chlamydia

A

Neonatal pneumonia

Opthalmia neonatorum

21
Q

Management of Chlamydia

A

prenatal screening

AZITHROMYCIN 1 g PO as a single dose - DOC

AMOXICILLIN 500 mg PO TID for 7 da

Alternatives - Erythromycin base or Erythromycin ethylsuccinate

sexual partners during the 60 days preceding the onset should be evaluated and treated

22
Q

Maternal Complications of Gonorrhea

A

septic abortion
preterm delivery, PROM
chorioamnionitis
postpartum infection (endometritis, PID)
accessory gland infection (Bartholin and Skene’s gland)
perihepatitis (Fits-Hugh-Curtis syndrome)
meningitis and endocarditis

23
Q

Perinatal Complications of Gonorrhea

A

opthalmia neonatorum
pharyngeal and respiratory tract infection
anal canal infection

24
Q

Management of Gonorrhea

A

Ceftriaxone 250 mg IM, single dose OR
Cefixime 400 mg/tab, single dose OR
Single dose injectible cephalosporin regimen

PLUS

Azithromycin 1 gram PO as single dose

PLUS

treatment for Chlamydial infection unless it is excluded

ALL NEWBORNS ARE GIVEN OCULAR PROPHYLAXIS
0.5 % erythromycin ointment w/n 1 hr after birth OR
1 % silver nitrate solution OR
1 % tetracycline ointment or solution

25
Q

Infections whose complications increase during pregnancy

A

UTI
Bacterial Vaginosis
Surgical wound
Group B Streptococcal

26
Q

Infections more common in pregnancy and the puerperium

A

Pyelonephritis
Endomyometritis
Mastitis
Toxic Shock Syndrome (TSS)

27
Q

Infections specific to pregnancy

A

Chorioamnionitis
Septic pelvic thrombophlebitis
Episiotomy or Perineal lacerations

28
Q

Infections that affect the fetus

A 
Neonatal sepsis (GBS, E. coli)
HSV
VZV
Parvovirus B19
CMV
Rubella
HIV
Hepatitis B and C
Gonorrhea
Chlamydia
Syphilis
Toxoplasmosis
Zika virus
29
Q

Treatment for UTI/Asymptomatic Bacteriuria

A

Amoxicillin
Nitrofurantoin
TMP-SMX
Cephalexin

30
Q

Treatment for Pyelonephritis

A

IV hydration
IV antibiotics
*Cephalosporins (Cefazolin, Cefotetan, or Ceftriaxone) OR Ampicillin and Gentamicin – until afebrile and asymptomatic for 24-48 hrs

31
Q

Major risk factors for developing pyelonephritis

A

Previous pyelonephritis
History of vesicoureteral reflux
ASB

32
Q

Maternal and Fetal Effects of Bacterial Vaginosis

A 
Abortion
PPROM
preterm delivery
Puerperal infections --- chorioamnionitis and endometritis
Postpartum endometritis
Post cesarean wound infection
33
Q

Intrauterine inflammation, infection or both (TRIPLE I)

MC precursor of neonatal sepsis

A

Chorioamnionitis

34
Q

Diagnosis for Triple I

A

2 > 38 C, 30 mins apart with additional clinical factor

  • elevated maternal WBC count (> 15 000/mL)
  • purulent fluid from cervical os
  • fetal tachycardia (> 160 bpm)
  • evidence from amniocentesis consistent with microbial invasion
35
Q

Gold standard for diagnosis of chorioamnionitis

A

Culture of amniotic fluid obtained via amniocentesis

36
Q

MCC of congenital viral infection

A 
Cytomegalovirus (CMV)
growth restriction
microcephaly, intracranial calcifications
chorioretinitis
mental and motor retardation
sensorineural deficits
hepatosplenomegaly, jaundice
hemolytic anemia
thrombocytopenic purpura (blueberry muffin baby)

OB (16 decks)

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